Determination of the Exit-Site
The exit-site should be identified and marked on the skin. This should be done in collaboration with the patient, the surgeon, the nephrologist, and the experienced PD nurse. The exit-site should be placed laterally either above or below the belt line, and it should not lie on a scar or in abdominal folds. It should be determined with the patient in an upright (seated or standing) position. Local trauma and hematoma during catheter placement should be avoided. The exit-site should be round and the tissue should fit snugly around the catheter. Sutures around the exit-site increase the risk of infection and should be avoided. The downward-directed exit-site is associated with significantly lower catheter related peritonitis . Prophylactic antibiotics given at the time of catheter placement decreases the risk of infection [4, 5]. Vancomycin (1 g IV, single dose) at the time of catheter insertion is found to be superior to cephalosporin (1 g IV single dose) in preventing early peritonitis . Eradication of nasal Staphylococcus aureus carriage significantly reduces ESI .
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